INSIDE INFORMATION

"Neurology is, in my opinion, the most interesting medical specialty. It is a clinical specialty heavily reliant on an ability to take a good history and perform an accurate examination. The diagnostic challenges are particularly enjoyable, frequently requiring one to venture beyond the usual diagnostic algorithms to consider more rare and exciting possibilities. Equally enjoyable is the ability to treat patients with an array of therapeutic options to transform previously devastating disorders into manageable conditions. This is also an evolving specialty with huge potential for future discovery."

Dr David Bourke, Neurology Registrar, Auckland District Health Board

Click on the questions below to view comments from more clinicians.

Why did you choose this specialty, and what do you most like about it?

 

	Neurology is a rapidly developing branch of medicine that still relies on traditional clinical skills and offers the chance to encounter a wide variety of conditions.

 

	Excellent clinical skills are essential. You should possess a keen interest in people and their personalities and behaviour, and be prepared to manage patients with chronic disability and those with severe acute illnesses. You need to have close attention to detail and be a bit of a perfectionist.

 

	At Auckland Hospital, full time neurologists work 8.00am to 6.00pm five days a week and share responsibility for after-hours call (usually one week in every eight or nine). Nine half-days a week are spent in clinical practice. The work allocation varies from month to month but generally includes outpatient clinics (general neurology and subspecialty clinics), neurology day ward, management of inpatients on the neurology ward, inpatient consultations on other wards and clinical neurophysiology. The remaining half-day each week is set aside for CME activities.

 

	In New Zealand at present there are only limited resources available to manage patients with neurological diseases.

 

	One contributor commented that he would encourage suitable candidates who are interested in neurology to pursue this career path because there is a national shortage of specialists.

 

	Plenty of opportunities exist in New Zealand. There is a shortage of neurologists in many centres and there are very few trainees in neurology at present. It is likely that the scope of neurological practice will increase in the next few years with the expansion of subspecialty areas (seen, for instance, in the development of dedicated stroke units).

 

	It is possible to take time out, but this should be carefully planned so that you manage to acquire necessary breadth and depth of clinical experience in the early stages of your career. Trainees should plan to spend at least two years of training overseas to expand clinical experience and knowledge, and to develop skills in subspecialty branches of neurology.

 

	After-hours work does not involve heavy obligations so neurology does not impact significantly on family life. A greater level of after-hours work may be required in the near future with the potential development of acute stroke management, although this commitment is unlikely to be onerous.

 

	Contributors did not identify any disadvantages that are specific to neurology, although the comment was made that remuneration is not as good as for other branches of internal medicine that have procedural components.

 

	Neurology trainees are strongly encouraged to complete a proportion of their advanced training overseas. Most trainees spend the first two years of advanced training in New Zealand (either two years in Auckland or one year in each of two other centres) and then complete their training overseas.